Provident’s Patient StatusEdge™ Supports Hospitals with CMS’ New Proposed Strategy to Reduce Medicare Appeals Backlog
Provident, a leader in healthcare management consulting and compliance solutions announces Patient StatusEdge™, a cloud-based appeals management program that simplifies the patient status audit and appeals process allowing hospitals to bring denials management in-house.
Detroit, MI – November 8, 2014 – Last week, the Centers for Medicare and Medicaid Services (CMS) announced a new strategy to reduce the backlog of Medicare appeals currently pending at the Administrative Law Judge level (level three). CMS is developing a process that allows providers to establish a dialogue with adjudicators at the first and second appeal levels with the goal that more denied claims will be resolved at the lower level of appeal. Provident’s Patient StatusEdge™, a cloud-based appeals management program, simplifies the audit and appeals process, allowing hospitals to efficiently produce well written and effective appeals and bring denials management in-house.
Provident’s Patient StatusEdge™ allows the Case Management department to managethe auditandappeal process, while also achieving continuous improvement. The auditing function of Patient StatusEdge™ evaluates the effectiveness of the Case Management program using inter-rater reliability testing and built-in auditing tools. More importantly, the program creates a concise visual representationof the patient’s plan of care to justify appropriate patient status and highlightkey events during the patient’s stay. The Patient Admission Summary Timeline depicts a visually friendly snap shot of the patient’s stay that hospitals can submit with the Memorandum of Law to support the original claim. The Patient Admissions Summary Timeline assists in explaining to the adjudicators, including the ALJs, the patient’s condition, risks and treatment and is referenced in the Memorandum of Law templates included in Provident’s Patient StatusEdge™. Hospitals can also reference the Patient Admission SummaryTimeline during in-person and telephone hearings with the ALJ, and with the MACs and QICs, pending implementation of CMS’ proposed strategy.
The Patient StatusEdge™ appeal function contains Memorandum of Law templates that physicians and nurses can complete in support of the stay to submit at every level of appeal. Provident has also opened the Mock ALJ Hearing Academy at select locations throughout the country to complement the Patient StatusEdge™ appeals function. With the Mock ALJ Hearing AcademyProvident’s team of experienced attorneys and physiciansteach hospital staff how to present cases to an ALJ during an in-person or telephone hearing. . After receiving step-by-step, hands-on individual training, hospital denials management staff will have the necessary tools to effectively present cases to an ALJ.
As Provident’s Chief Executive Officer, Michael Dougherty, recently stated, “Now more than ever before, hospitals will have the opportunity to make their case to MACs and the QICs. With this in mind, we developed Patient StatusEdge™ and the Mock ALJ Hearing Academy to alleviate the burden of managing the appeals process and allow hospitals to achieve continuous improvement for case managers, providers and physician liaisons.”
Provident Consulting is a leader in Healthcare Management and Compliance Solutions. We understand the diverse risks our healthcare clients face. Our proven solutions, expertise and specialized tools transcend traditional strategies and assumptions and focus on regulatory, operational and financial optimization to help clients thrive in the future of healthcare.
Provident’s solutions are focused on the integrity of the clinical record to support quality patient care, manage compliance with law and regulation, secure appropriate reimbursement, and give healthcare leaders actionable clinical data to drive success.
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